MCD Care, LLC

Primary specialty

Custodial Care FacilityTaxonomy code 311Z00000X

Legal business name

MCD CARE, LLC

Doing business as

Keith Street Manor

Practice address

351 Keith St
Park Hills, MO 63601-2049

Phone

(573) 518-0444

Fax

(573) 518-0453

NPI assigned

May 10, 2013

Last updated

May 10, 2013By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Daphne Ilene McDonald

Title

LLC Member

Phone

(573) 518-0444

Specialties & licenses 1

Addresses

Other names 1

• Keith Street Manor Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1368144000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1368144000000",
    "number": "1831535301",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 394",
            "city": "PARK HILLS",
            "state": "MO",
            "postal_code": "636010394",
            "telephone_number": "573-518-0444",
            "fax_number": "573-518-0453"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "351 KEITH ST",
            "city": "PARK HILLS",
            "state": "MO",
            "postal_code": "636012049",
            "telephone_number": "573-518-0444",
            "fax_number": "573-518-0453"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MCD CARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-05-10",
        "last_updated": "2013-05-10",
        "status": "A",
        "authorized_official_last_name": "MCDONALD",
        "authorized_official_first_name": "DAPHNE",
        "authorized_official_middle_name": "ILENE",
        "authorized_official_title_or_position": "LLC MEMBER",
        "authorized_official_telephone_number": "573-518-0444",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "311Z00000X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Keith Street Manor",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Tonya Monique Long, DMD
• Carrie Lorentz, MA, SLP LICENSE
• Jacklyn Lowry, LPN
• Walter Major, LPC
• Susan McCarron, LPN
• Ashley Brooke McFarland
• Robene McKoy, RN
• Martha A McMurry, LPC
• Ivy Meinershagen, DC
• Michael L Edgar DDS PC

• Custodial Care Facility in Park Hills, MO
• Providers in Park Hills, MO by specialty
• Custodial Care Facility in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 10, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.